Changes in high sensitivity serum CRP under periodontal therapy and its association with the depth of pathological periodontal pocket

Periodontitis is a chronic inflammatory disease, elicited by a complex mixture of anaerobic, Gram-negative bacteria that result in the destruction of the supporting structures of the dentition (Pihlstrom et al, 2005). This disease affects the majority of population (Brown et al, 1996) and the periodontal tooth mortality was reported by Ong, 1998 to be associated with the loss of periodontal attachment. C-reactive protein, as an acute-phase reactant, currently being labelled as a possible risk indicator for future cardiac events, and it is elevated in periodontitis patients compared to controls (Ebersole et al, 1997). Despite the fact for effectiveness of periodontal treatment in modifying the level of serum levels of C-reactive protein (CRP) and interleukin-6 (IL-6) (Ebersole et al., 1997, Mattila et al., 2002), incomplete or inadequate treatment of extensive periodontal disease will not be expected to have a significant impact on systemic mediators (Ioannidou et al., 2006). The aim of this study was to explore the outcomes of periodontal therapy in terms of changes in C-reactive protein (CRP) and its effect on the depth of pathological periodontal defect. Following protocol review and approval by Institutional Review Board of Jordan university of science and technology, a total of fifty five periodontitis patients randomly distributed into either a treatment group (37 patients) received non-surgical periodontal therapy with intensive oral hygiene nstructions and repeated therapy course for residual bleeding periodontal pockets or control group (18 patients) received delayed periodontal treatment after completion of clinical trial evaluation. Medical history, demographic data and clinical periodontal parameters and C-reactive protein were collected at baseline and three months at reassessment appointments. The results showed statistically significant improvements for all periodontal clinical parameters, and significant reduction of hs-CRP levels (p=0.003) after the treatment regime within the tested treatment group compared to control patients, and there was a significant positive correlation (p=0.006, r=0.411) between elevated serum levels of CRP and deep pathological periodontal pockets

The relationship between diabetes mellitus, periodontal health status and dental caries

Objectives: To study the relationship between diabetes mellitus, periodontal health status and dental caries. Materials and methods: A case-control study involving 42 type II diabetic patients and 42 non-diabetic patients was conducted at Polyclinic, Kulliyyah of Dentistry, International Islamic University Malaysia. Their decay, missing, filling, total scores (DMFT) and full mouth periodontal parameters were recorded. Patients’ sociodemographic background was obtained and diabetic profile was assessed. Results: The percentage of diabetic patients that were diagnosed with periodontitis was 88.1% compared to 59.5% in the control group and it was statistically significant (p0.05) while the clinical attachment loss (CAL) showed significant difference (p<0.05). The mean values for decay, missing and filled teeth in the diabetic group were 2.24(±1.94), 8.52(±6.13) and 3.76(±2.79) respectively, while in the control group were 1.83(±1.92), 4.79(±3.8) and 2.79(±2.76) respectively. Among all three mean values, missing teeth was the only one that showed significant difference (p<0.05). However, the total DMFT score between the two groups showed statistically significant results (p<0.05). Among the diabetic patients, there was no significant difference between those with high random blood glucose level and those with normal level in terms of the periodontal parameters and DMFT. Conclusions: Diabetes mellitus negatively affects oral health as reflected by the higher DMFT scores in diabetic patients. There was also a greater prevalence and severity of periodontitis in diabetic subjects than in nondiabetics

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Early mobilisation in critically ill COVID-19 patients: a subanalysis of the ESICM-initiated UNITE-COVID observational study

Background Early mobilisation (EM) is an intervention that may improve the outcome of critically ill patients. There is limited data on EM in COVID-19 patients and its use during the first pandemic wave. Methods This is a pre-planned subanalysis of the ESICM UNITE-COVID, an international multicenter observational study involving critically ill COVID-19 patients in the ICU between February 15th and May 15th, 2020. We analysed variables associated with the initiation of EM (within 72 h of ICU admission) and explored the impact of EM on mortality, ICU and hospital length of stay, as well as discharge location. Statistical analyses were done using (generalised) linear mixed-effect models and ANOVAs. Results Mobilisation data from 4190 patients from 280 ICUs in 45 countries were analysed. 1114 (26.6%) of these patients received mobilisation within 72 h after ICU admission; 3076 (73.4%) did not. In our analysis of factors associated with EM, mechanical ventilation at admission (OR 0.29; 95% CI 0.25, 0.35; p = 0.001), higher age (OR 0.99; 95% CI 0.98, 1.00; p ≤ 0.001), pre-existing asthma (OR 0.84; 95% CI 0.73, 0.98; p = 0.028), and pre-existing kidney disease (OR 0.84; 95% CI 0.71, 0.99; p = 0.036) were negatively associated with the initiation of EM. EM was associated with a higher chance of being discharged home (OR 1.31; 95% CI 1.08, 1.58; p = 0.007) but was not associated with length of stay in ICU (adj. difference 0.91 days; 95% CI − 0.47, 1.37, p = 0.34) and hospital (adj. difference 1.4 days; 95% CI − 0.62, 2.35, p = 0.24) or mortality (OR 0.88; 95% CI 0.7, 1.09, p = 0.24) when adjusted for covariates. Conclusions Our findings demonstrate that a quarter of COVID-19 patients received EM. There was no association found between EM in COVID-19 patients' ICU and hospital length of stay or mortality. However, EM in COVID-19 patients was associated with increased odds of being discharged home rather than to a care facility. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021)

Effects of nonsurgical periodontal therapy on leukocytes, erythrocytes and haemoglobin

Aim The aim of this study was to assess the outcome of the nonsurgical periodontal treatment in terms of its effect on leukocytes, erythrocytes and haemoglobin in consecutive subjects diagnosed with chronic periodontitis. Methods After obtaining the ethical approval from the ethics committee of the International Islamic University Malaysia, 25 systematically healthy Malaysian subjects diagnosed with chronic periodontitis were recruited for the study. Detailed oral hygiene instruction and standard periodontal therapy were performed. Full clinical periodontal parameters including full mouth plaque scores, bleeding on probing, pocket depth and clinical attachment loss were recorded and re-evaluated 3 months after the treatment completion. Blood samples were collected to determine the complete blood count at baseline and 3 months after the periodontal treatment. Results Nonsurgical periodontal therapy resulted in significant reduction in the white blood cells (WBC) where the average WBC decreased from 8.3 103/uL at baseline to 7.6 103/uL (p=0.038) after 3 months of periodontal therapy, and significant decrease in the monitored erythrocyte sedimentation rate (ESR) from 8.3 mm/hr to 5.9 mm/hr (p=0.033). However, the results of this study failed to show significant difference in the erythrocytes and haemoglobin (p>0.05) after the marked improvement in the scored clinical periodontal parameters in response to the periodontal therapy. Conclusion This study demonstrated that nonsurgical periodontal therapy results in a significant reduction in the white blood cells count and ESR

The assessment of serum lipid level among a sample of Kuantan patients with periodontal diseases

Data on whether periodontal therapy affects serum lipid levels are inconclusive. This study was to explore the relationship between periodontal diseases and serum lipid level, investigating its link to various systemic diseases related to hyperlipidemia. Thirty systemically healthy patients with periodontal disease were recruited for the study. All subjects underwent oral examination and their clinical periodontal parameters were recorded. Five milliliters of fasting venous blood sample was drawn and tested for the systemic levels of total cholesterol, triglyceride (TG), high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The results revealed the mean lipid serum levels (mmol/L) at the baseline are 4.9 (1.0), 1.2 (0.48), 1.6 (0.58), and 2.8 (0.83) for the total cholesterol, TG, HDL and LDL respectively. There is a positive correlation between the lipid serum levels and clinical periodontal parameters represented by the percentage of sites with the presence of plaque, mean clinical attachment loss and the percentage of sites with moderate pocket depth, but this correlation failed to reach the statistical significance. This study demonstrated that patients with periodontal disease have no significant correlation with serum lipid levels (p>0.05), however subjects with increased level of bleeding on probing reflected significant non-desirable level of HDL (p = 0.006)

Effects of nonsurgical periodontal therapy on high-sensitivity serum c-reactive protein and ESR among Malaysian population with chronic periodontitis

Objectives: The aim of this study was to assess the outcome of the nonsurgical perio¬dontal treatment in terms of its effect on the hs-CRP and ESR in consecutive subjects diagnosed with chronic periodontitis in order to improve sensitivity and specificity. Methods: 25 systematically healthy subjects diagnosed with chronic periodon¬titis were recruited for the study after obtaining the ethical approval from the ethics committee of the International Islamic University Malaysia. Detailed oral hygiene instruction and standard periodontal therapy were performed. Full clinical periodontal parameters including full mouth plaque scores, bleeding on probing, pocket depth and clinical attachment loss were recorded and re-evaluated 3 months after the treatment completion. Blood samples were collected to determine the high-sensitivity serum C-reactive and the erythrocyte sedimenta¬tion rate at baseline and 3 months after the periodontal treatment. Results: Nonsurgical periodontal therapy resulted in significant reduction in the se¬rum CRP level where the average CRP decreased from 1.8 mg/L at baseline to 1.6 mg/L (p=0.009) after 3 months of periodontal therapy, and the marked improvement in the recorded periodontal parameters were confirmed by the significant decrease in the monitored ESR from 8.3 mm/hr to 5.9 mm/hr (p=0.033). Conclusions: In terms of sensitivity and specificity this study demonstrated that nonsurgical periodontal therapy results in a significant reduction in the serum CRP level and ESR

The influence of periodontal treatment on serum lipid and systemic marker levels in patients with destructive periodontal disease

Objectives: Data on whether periodontal therapy affects serum lipid levels is inconclusive. The purpose of this study is to investigate the effect of nonsurgical periodontal therapy on the cholesterol levels and hs-CRP of medically healthy individuals suffering from advanced periodontitis. Methods: Following protocol review and approval by the Institutional Review Board of Jordan University of Science and Technology a total of fifty five periodontitis patients randomly distributed into either a treatment group (37 patients) who received non-surgical periodontal therapy with intensive oral hygiene instructions and a repeated course of therapy for residual bleeding in periodontal pockets or a control group (18 patients) who received delayed periodontal treatment after completion of the clinical trial evaluation. Medical history, demographic data and clinical periodontal parameters, total cholesterol, LDL, HDL, triglyceride, and C-reactive protein were collected at baseline and three months at reassessment appointments. Results: The results showed statistically significant improvements for all periodontal clinical parameters and the non-surgical periodontal therapy had no effect on the lipid parameters (P-Value=0.322, 0.540, 0.451, and 0.154 for LDL, HDL, Total Cholesterol, and Triglycerides respectively) in contrast to the significant decrease in the infl ammatory marker CRP (P-Value=0.003). Conclusions: In this study population, serum lipid levels were not associated with any improvement in periodontal heath while the destructive periodontal disease associated with increased circulating concentrations of his-CRP and the periodontal therapy reduces CRP levels

Association between cardiovascular disease parameters and chronic periodontitis

Aim: The aim of this study was to investigate the association between cardiovascular risk markers and chronic periodontitis. Material and Methods: A total of 40 healthy individuals were included in this case control study and categorized into two groups of 20 subjects each. Of these, 20 patients were controls with no clinical attachment loss and 20 patients had chronic periodontitis. Detailed clinical periodontal parameters were recorded from all participants. Serum samples were collected for the evaluation of high sensitive CRP (Hs-CRP) and lipids. The leukocyte (WBC) parameters were evaluated from peripheral blood samples. Results: Statistically significant differences were detected between both groups in respect to leukocyte counts and serum Hs-CRP levels (p-value=0.003 and <0.001 respectively). There were no significant differences between serum lipid levels of the case and control groups. Conclusions: The local periodontal inflammation may influence the systemic inflammation level by increasing the serum Hs-CRP and leukocytes count in patients with chronic periodontitis